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Orthopedics > Forearm > Flashcards

Forearm Flashcards

1
Q

What type of scaphoid fracture are at risk of malunion/AVN

A

proximal fx

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2
Q

What is a Monteggia fracture?

A

proximal ulna fracture (of anterior angulation) resulting in radial head dislocation (often anterior)

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3
Q

complications of Monteggia fracture

A

radial nerve injury, compartment syndrome

nonunion, decreased ROM, etc

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4
Q

what is Galeazzi fracture?

A

distal 1/3 radial shaft fracture and distal radioulnar joint dislocation

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5
Q

What is the most common distal radius fracture

A

colles fracture

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6
Q

distal radius fracture with dorsal displacement (of distal bone fragment)?

A

colles fracture

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7
Q

distal radius fracture with volar displacement

A

smiths fracture

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8
Q

what part of carpal tunnel may compress on the median nerve

A

transverse carpal ligament

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9
Q

what are the contents of the carpal tunnel?

A

9 tendons - FDS (4), FDP (4), FPL

Median nerve

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10
Q

What is Kienbock’s disease?

A

avascular necrosis of the lunate

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11
Q

What test test for de quervain’s tenosynovitis

A

Finkelstein

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12
Q

pronator teres origin and insertion

A

O: medial epicondyle
I: lateral radius - middle 1/3

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13
Q

pronator teres innervation

A

median nerve

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14
Q

pronator teres action

A

pronate and flex forearm

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15
Q

what nerve is compressed in pronator syndrome

A

median nerve

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16
Q

flexor carpi radialis (FCR) origin and insertion

A

O: medial epicondyle
I: 2nd and 3rd metacarpal

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17
Q

FCR innervation

A

median nerve

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18
Q

FCR action

A

flex wrist

radial deviation

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19
Q

what muscle is the radial artery immediately lateral to?

A

FCR

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20
Q

palmaris longus origin and insertion

A

O: medial epicondyle
I: Flexor retinaculum/palmar aponeurosis

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21
Q

palmaris longus innervation

A

median nerve

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22
Q

palmaris longus action

A

flex wrist

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23
Q

what muscles tendon is commonly used for tendon transfers

A

palmaris longus

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24
Q

FCU origin and insertin

A

O: medial epicondyle and posterior ulna
I: pisiform, hook of hamate, 5th metacarpal

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25
Q

FCU innervation

A

ulnar nerve

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26
Q

FCU action

A

flex wrist, ulnar deviation

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27
Q

what is the most powerful wrist flexor

A

FCU

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28
Q

FCU may compress which nerve?

A

ulnar

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29
Q

FDS origin and insertion

A

O: 2 heads - humeroulnar and radial heads

  1. medial epicondyle and proximal ulna
  2. anteroproximal radius

I: Middle phalanges of digits (not thumb)

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30
Q

FDS innervation

A

median

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31
Q

FDS action

A

flex PIPJ (and flex digit and wrist)

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32
Q

FDP origin and insertion

A

O: anterior ulna and interosseous membrane
I: distal phalanx (IF, +/- MF, RF, SF)

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33
Q

FDP innervation

A

IF, +/- MF – median nerve/anterior interosseous nerve

+/- MF, RF, SF – ulnar nerve

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34
Q

FDP action

A

flex DIPJ (also flex digit and wrist)

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35
Q

what is jersey finger

A

avulsion of FDP from its distal insertion on the distal phalanx

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36
Q

FPL origin and insertion

A

O: anterior radius and proximal ulna
I: distal phalanx of thumb

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37
Q

FPL innervation

A

median n/AIN

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38
Q

FPL action

A

flex thumb

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39
Q

what does the AIN innervate

A

all three deep flexors (along with median nerve)

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40
Q

how do you test AIN function?

A

make okay sign

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41
Q

what muscules are most susceptible to Volkmann’s contracture

A

FDP and FPL

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42
Q

origin and insertion of pronator quadratus

A

O: medial distal ulna
I: anterior distal radius

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43
Q

pronator quadratus innervation

A

median nerve/AIN

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44
Q

pronator quadratus action

A

pronate forearm

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45
Q

primary pronator?

A

pronator quadratus

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46
Q

anconeus origin and insertion

A

O: posterior lateral epicondyle
I: posterior proximal ulna

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47
Q

anconeus innervation

A

radial nerve

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48
Q

anconeus action

A

forearm extension

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49
Q

extensor digitorum/extensor digitorum communis origin and insertion

A

O: later epicondyle
I: MCP - sagital band, P2 central slip, P3 terminal slip (digits 2-5)

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50
Q

extensor digitorum/extensor digitorum communis innervation

A

radial/PIN

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51
Q

extensor digitorum/extensor digitorum communis action

A

extend digits

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52
Q

boutonniere is caused by tendon avulsion of what muscle and where?

A

extensor digitorum/extensor digitorum communis at P2

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53
Q

mallet finger is caused by tendons avulsion of what muscle and where

A

extensor digitorum/extensor digitorum communis at P3

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54
Q

extensor digiti minimi (EDM) origin and insertion

A

O: lateral epicondyle
I: MCP - sagital band, P2 central slip, P3 terminal slip of digit 5 (small finger)

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55
Q

extensor digiti minimi (EDM) innervation

A

radial/PIN

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56
Q

extensor digiti minimi (EDM) action

A

little finger extension

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57
Q

extensor carpi ulnaris origin and insertion

A

O: lateral epicondyle
I: base of 5th MC

58
Q

extensor carpi ulnaris innervation

A

radial/PIN

59
Q

extensor carpi ulnaris action

A

hand extension and adduction

60
Q

which muscle can cause painful snapping over the ulna

A

extensor carpi ulnaris

61
Q

name the superficial extensors

A

aconeus
extensor digitorum communis
extensor carpis ulnaris
extensor digiti minimi

62
Q

brachioradialis muscle origin and insertion

A

O: lateral condyle
I: lateral distal radius

63
Q

brachioradialis innervation

A

radial

64
Q

brachioradialis action

A

flex forearm

65
Q

what muscle is a deforming force in radius fractures

A

brachioradialis

66
Q

extensor carpi radialis longus action

A

wrist extension

67
Q

extensor carpi radialis longus origin and insertion

A

O: lateral condyle
I: base of 2nd MC

68
Q

extensor carpi radialis longus innervation

A

radial nerve

69
Q

extensor carpi radialis brevis origin and insertion

A

O: lateral epicondyle
I: base of 3rd MC

70
Q

extensor carpi radialis brevis innervation

A

radial nerve/PIN

71
Q

extensor carpi radialis brevis action

A

wrist extension

72
Q

what muscle tendon degenerates in tennis elbow?

A

extensor carpi radialis brevis

73
Q

supinator origin and insertion

A

O: posterior medial ulna
I: proximal lateral radius

74
Q

supinator innervation

A

radial/PIN

75
Q

supinator action

A

forearm supination

76
Q

abductor pollicis longus origin and insertion

A

O: posterior radius/ulna
I: base of 1st metacarpal

77
Q

abductor pollicis longus innervation

A

radial/PIN

78
Q

abductor pollicis longus action

A

abduct and extend thumb (CMCJ)

79
Q

what tendon is affected in de Quervain’s disease

A

abductor pollicis longus

80
Q

extensor pollicis brevis origin and insertion

A

O: posterior radius
I: base of thumb proximal phalanx

81
Q

extensor pollicis brevis innervation

A

radial/PIN

82
Q

extensor pollicis brevis action

A

extend thumb (MCPJ)

83
Q

extensor pollicis longus origin and insertion

A

O: posterior ulna
I: base of thumb distal phalanx

84
Q

extensor pollicis longus innervation

A

radial/PIN

85
Q

extensor pollicis longus action

A

extend thumb (IPJ)

86
Q

which tendon will turn 45 degrees as Lister’s tubercle

A

extensor pollicis longus

87
Q

what muscles comprise superficial extensors

A

anconeus
extensor carpi ulnaris
extensor digiti minimi
extensor digitorum communis

88
Q

extensor indices proprius origin and insertion

A

O: posterior ulna
I: MCP - sagital band, P2 - central slip, P3 - terminal slip

89
Q

extensor indices proprius innervation

A

radial/PIN

90
Q

extensor indices proprius action

A

extend index finger

91
Q

What nerve provides sensory to the volar wrist capsule

A

AIN

92
Q

What nerve provides sensory function to the posterior forearm?

A

radial nerve via the posterior cutaneous nerve of forearm

93
Q

what does the PIN provide sensory function to?

A

dorsal wrist capsule

94
Q

what nerve provides sensory function to the radial forearm?

A

musculocutaneous nerve (C5-C7) via lateral cutaneous nerve of forearm

95
Q

what nerve provides sensory function to medial forearm?

A

medial cutaneous nerve of forearm (C8-T1)

96
Q

What another name for ulnar tunnel

A

Guyon’s canal

97
Q

What supplies the scaphoid? %?

A

Palmar scaphoid branch (from superficial palmar branch - which anastomoses with superficial palmar arch from radial artery) – supplies 25% of distal scaphoid

Dorsal scaphoid branch (from radial artery)– supples 75% of proximal scaphoid

98
Q

signs of triangular fibrocartilage complex tear?

A

ulnar wrist pain

Pain worse with ulnar deviation

+Fovea sign - tenderness in the soft spot between the ulnar styloid and flexor carpi ulnaris tendon, between the volar surface of the ulnar head and the pisiform

99
Q

How can TFCC tear occur

A

class 1 - traumatic (associated with ulnar styloid fx)

Class 2 - degenerative

100
Q

how is TFCC tear treated

A

typically conservatively with NSAIDs and immobilization

In severe cases - repair/debride tear (traumatic) or ulnar shortening procedure

101
Q

what is de quervain’s tenosynovitis

A

inflammation of the first dorsal compartment - APL/EPB

associated with tendon abnormality. Often occurs in middle aged women

102
Q

treatment of de quervain’s tenosynovitis

A
  1. Splint and NSAIDs
  2. Corticosteroid injection into sheath
  3. Surgical release
103
Q

most common area for ganglion cyst to occur

A

dorsal wrist - SL joint

104
Q

Sites where median nerve compression can occur causing pronator syndrome

A
  1. Ligament of Struthers
  2. Pronator teres
  3. Bicipital aponeurosis
  4. FDS aponeurosis/arch
105
Q

What is pronator syndrome

A

proximal median nerve compression

106
Q

What is AIN syndrome

A

Rare nerve compression

same sites as pronator syndrome (ligament of struthers, pronator teres, FDS aponeurosis/arm, bicipital aponeurosis)

motor symptoms only

107
Q

Symptoms/PE of AIN syndrome

A

Hx: weakness, +/- pain
PE: weak thumb (FPL) and index finger pinch (FDP)

108
Q

Symptoms/PE of pronator syndrome

A

Hx: numbness, tingling, +/- weakness
PE: decrease palm sensation, + pronator or FDS sign

109
Q

What is carpal tunnel associated with?

A

metabolic diseases - thyroid disease, diabetes, pregnancy

110
Q

Hx and PE for carpal tunnel

A

numbness, +/- pain

PE: +/- thenar atrophy, + Tinel/Phalen/Durkin’s

111
Q

Treatment for pronator/AIN syndrome

A
  1. Activity mod/rest
  2. NSAIDs, splinting
  3. Surgical decompression of all proximal sites
112
Q

Treatment for carpal tunnel syndrome

A
  1. Activity modification
  2. NSAIDs, night splints
  3. Corticosteroid injections
  4. Surgical decompression
113
Q

what is PIN syndrome and where can it occur?

A

Compression in radial tunnel

  1. fibrous bands
  2. leash of henry - aka recurrent radial artery
  3. extensor carpi radialis brevis
  4. Arcade of Frohse (proximal supinator edge)
    5 Distal edge of supinator
114
Q

Hx/PE for PIN syndrome

A

Hx: hand/wrist weakness, +/- elbow pain

PE : weak thumb/ finger extension; tenderness to palpation at radial tunnel

115
Q

Workup for PIN syndrome?

A

XR: look for radiocapitellar abnormality

MR: evaluate for masses

EMG/NCS: confirms diagnosis and localizes lesions

116
Q

treatment for PIN syndrome?

A
  1. activity mod
  2. NSAIDs/splints
  3. complete surgical decompression
117
Q

How does radial tunnel syndrome differ from PIN syndrome?

A

Pain only, no weakness

118
Q

How does AIN syndrome differ from pronator syndrome?

A

motor symptoms only (+/- pain)

119
Q

What areas can cause radial tunnel syndrome

A

same as PIN syndrome:

  1. fibrous bands
  2. leash of henry - aka recurrent radial artery
  3. extensor carpi radialis brevis
  4. Arcade of Frohse (proximal supinator edge)
    5 Distal edge of supinator
120
Q

Work up for radial tunnel syndrome?

A

XR: evaluate RC joint
MRI: evaluate for masses
EMG/NCS: no useful

121
Q

treatment for radial tunnel syndrome

A
  1. activity mod
  2. NSAIDs/splints
  3. complete surgical decompression
122
Q

What is Wartenberg’s syndrome?

A

Compression of superficial radial nerve at the wrist between ECRB and BR tendons

sensory symptoms only

123
Q

Hx/PE for Wartenberg’s syndrome

A

Hx: pain and paresthesias of the dorsoradial hand without motor symptoms
PE: decreases sensation at IF and thumb, +Tinel’s sign with pronation

124
Q

workup for Wartenbergs syndrome

A

XR and MRI not helpful

EMG/NCS maybe helpful

125
Q

treatment for Wartenbergs syndrome

A
  1. activity mod
  2. NSAIDs/splints
  3. complete surgical decompression
126
Q

what is ulnar tunnel syndrome

A

Compression of the ulnar nerve at the ulnar tunnel (Guyon’s canal) located at the wrist

127
Q

etiology of ulnar tunnel syndrome

A
  1. ganglion (MC)
  2. hamate malunion
  3. thrombotic artery
  4. muscle
128
Q

Hx/PE of ulnar tunnel syndrome

A

Hx: Numbness, weakness in hand
PE: paresthesias and weakness of small finger and ring finger, +Tinel sign over Guyon’s canal

129
Q

Treatment of ulnar tunnel syndrome

A
  1. activity mod
  2. NSAIDs/splints
  3. surgical decompression or address underyling cause (e.g. ganglion excision)
130
Q

work up for ulnar tunnel syndrome

A 
XR: look for fracture (hook of hamate)
CT: for fx or malunion)
MR: useful for masses
US: evaluate for thrombosis
EMG: confirms diagnosis
131
Q

What is the name for instability within a carpal row (two types)

A

Carpal instability, dissociative (CID)

132
Q

What are the two types of carpal instability dissociative

A
  1. Dorsal intercalated segment instability (DISI)

2. Volar intercalated segment instability (VISI)

133
Q

etiology of dorsal intercalated segment instabiilty

A
  • due to scapholunate ligament disruption or scaphoid fx/nonunion
  • deformity: scaphoid flexes, lunate extends
  • may lead to Scaphotrapeziotrapezoidal (STT) arthritis or scapholunate advanced collapse (SLAC)
134
Q

What is etiology of volar intercalated segment instability?

A
  • due to lunotriquetral ligament disruption (also requires dorsal radiocarpal ligament injury)
135
Q

Hx for carpal instability dissociative?

A

Trauma, pain, +/- popping

136
Q

PE findings for carpal instability dissociative?

A

+/- decreased ROM

+/- snuffbox or SL/LT interval tenderness, + Watson test (DISI) or Regan test (VISI)

137
Q

Evaluation for carpal instability dissociative?

A

XR - wrist and clenched fist views

MRA - can confirm ligament injury

138
Q

What would you see on XR in a DISI

A

SL gap > 3 mm

SL angle >70 degrees

“ring sign”

139
Q

what would you see on XR in VISI

A

disrupted carpal arches

140
Q

Treatment for CID

A

Acute/early

  • Fx: ORIF of scaphoid
  • Ligament: SL or LT ligament repair or reconstruction with pin fixation
  • Capsulodesis

Chronic/Late
- Limited fusion

Orthopedics (6 decks)

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